Voice Disorders

1
Voice Disorders

• Chapter 3 in Boone, et.al.

2

• Etiology a science or doctrine of causation or
  of the demonstration of causes.
• A symptom is a complaint.
• Signs are characteristics of the voice that can
  be observed or tested.
•  

3

• Major Symptoms of Voice Problems
•  
• Hoarseness
• Vocal fatigue
• Breathy Voice
• Reduced phonation range
• Aphonia
• Pitch breaks or inappropriately high pitch
• Tremor
• Pain and other physical sensations

4
Etiological Categories

• Functional
• Organic
• Neurological

5
Faulty Usage Functional Etiology

• Falsetto
• High pitched and breathy
• Down-word pitch breaks
• Too high for the speaker
• Functional aphonia
• Client loses voice
• Results after illness/stress event
• Young females
• Functional dysphonia
• Problem with voice

6

• Muscle tension dyspsonia
• Excessive muscle tension
• Side to side tension
• VF tension
• Sphincter-like closure of
• supraglottal area
• Underadduction of folds
• Diplophonia
• Double voice
• Vibration difference in folds
• Aryepiglottic/ventricular fold vibration

7

• Ventricular dysphonia
• Vibration of false folds
• Vibration of vf incorrectly
• Maybe compensation due to structural change
• Monotone, low pitch, hoarse, breathy
• Pitch breaks
• Developmental in during puberty
• Vocal hyperfunction vocal limping
• Increase in pitch for short period of time

8

• Phonation breaks
• Temp loss of voice word, phrase or sentence
• Effort, talk to hard
• Accompanied by coughing or excessive throat
  clearing

9
Functional Etiology

• Vocal fold thickening
• Broad based lesion
• May be precursor to nodules or polyps
• Result of prolonged irritation
• Reinkes edema
• Swelling from chronic abuse
• Fluid accumulates in Reinkes space in response
  to repeated vocal trauma
• Smokers
• http//www.medicine.uiowa.edu/otolaryngology/cases
  /reinke/reinke1.htm

10

• Polyps
• Soft, fluid filled lesion
• Often unilateral
• Voice is horse, breathy
• and need for throat clearing
• Usually caused by single event
• of vf abuse
• Hemorrhage
• Surgical and rehab therapy
• http//www.medicine.uiowa.edu/otolaryngology/cases
  /polyp/polyp1.htmpreop_audio

11

• Nodules
• Most common benign lesion
• Bilateral on glottal margin
• Result of continued abuse/misuse
• Develop at the anterior 1/3 middle 1/3 junction
• http//www.medicine.uiowa.edu/otolaryngology/cases
  /nodules/nodules1.htm

12

• Traumatic laryngitis
• Swelling from strained vocalization
• Edema, irritation, high blood accumulation
• May lead to nodules, polyps or thickening

13
Organic Changes of the Vocal Mechanism

• Cancer
• Treatment-Microsurgery and radiation
• Could be caused by smoking, chronic infections,
  smokeless tubacce, herpes, repeated trauma,
  leukoplakia
• Supraglottal, glottal or subglottal location
• Laryngectomy
• Removal of larynx
• Disease or trauma

14

• Leukoplakia
• Whitish patches on vocal folds/tongue
• Result of smoking

15

• Congenital anomalies
• Laryngomalacia- pliable epiglottis but will
  outgrow by 18 months 75 of lary
• Subglottal stenosis congenital or acquired
• ( after prolonged intubation)
• atresia occlusion

16

• Hyperkeratosis
• Pinkish Lesions
• May be precusor to cancer
• Due to irritation/smoking
• Under tongue, vf at thyroid or arytenoid
  commissure
• Endocrine changes
• Hormones abnormalities
• Pitch changes
• Tumor growth

17

• Pubertal changes
• Voice changes at puberty for boys and girls
• Voice pitch drop for boy and girls
• Boys may experience pitch breaks

18

• Infectious laryngitis
• URI or head and chest cold
• Virus or bacteria
• Made improve with vocal rest, humidifier, fluids
  and rest

19

• Papilloma virus
• Wart-like growth
• In young children underage of six must have
  evaluation after hoarseness for 10 days (if not
  after an URI)
• Can obstruct airway
• Medical/surgery intervention
• http//www.medicine.uiowa.edu/otolaryngology/cases
  /papillom/papillo1.htm

20

• Sulcus vocalis
• Congenital or unknown etiology
• From vocal abuse or LPR
• Long oval shaped opening of glottis during
  adduction, typically bilaterally
• Decreased intensity, breathy voice

21

• Reflux
• GERD or LPR
• 4-10 of laryngeal complaints are result of
  reflux
• Behavioral, pharmacological, medical
• http//www.nature.com/gimo/contents/pt1/full/gimo4
  6.html

22

• Contact ulcers
• Small ulcerations on medial aspect of vocal
  process
• Causes (1)excessive slamming of ary-loudness,
  freq. throat clearing and coughing, hard glottal
  attack, low pitch and sudden onset of phonation
• (2) LPR
• (3) intubation
• Symptoms- deterioration of voice, pain in
  laryngeal area or pain lateralized to one ear

23

• Granuloma
• Causes (1) intubation
• (2) trauma from abuse/misuse
• (3) LPR
• Persistent hoarseness, irritation of vf,
  breathiness, dysphonic , throat clearing
• Treatment - medical and voice therapy
• http//emedicine.medscape.com/otolaryngologylaryn
  gology

24

• Webbing
• Web grow across the glottis
• Congenital or acquired
• Membranous tissue remains or irritation to
  mucosal surface or trauma to larynx
• Hoarseness, high pitched
• Surgical intervention and voice therapy following